Duty of Care and Negligence - Case Study Example

Name: Tutor: Title: Case Analysis: Duty of care and Negligence Institution: Date: Abstract: The nursing practice is subject to a range of legal, ethical and professional duties. The main one involves the duty of care owed to patients. Ethical and legal implications may arise when duty of care is breached. This article examines a case study in which a breach of duty of care due to failure to work as a patient advocate complicates the progress of a patient. It concludes that such scenarios could be easily managed through a balance of power in the nurse-client relationship, where professional intimacy is ensured. The same case should apply to the nurse-nurse relationship. Case Analysis: Duty of Care and Negligence Legally, negligence means breach of duty. In any case, a mistake that may happen does not necessarily imply that negligence has occurred (Ruthe and Ashley 2004b). Breaches of duty that are generally considered as negligent in nursing include ‘taking actions that a reasonably average person would not do.” Depending on the circumstances, it may also mean the failing to take action that a reasonably average person would take. Therefore, negligence in nursing denotes failure to use reasonable or ordinary care (Klainberg 2010). To determine whether negligence of duty has occurred, circumstantial evidence and assumptions are put into account. Generally, five key elements are examined. These include whether the nurse had a duty to perform, whether there was a violation or breach of care, whether appropriate care was necessary in the circumstance, whether an injury resulted from the negligence and lastly, whether there is evidence that damages happened as a direct consequence of the negligence (Eileen 2003). In the case study several breaches of duty of care are identified. First, Pamela and Jane have failed in their duty as patient’s advocate. Jackson et al (2010) and Kibble (2012) specify the role of a nurse as a patient advocate. In their view, patients are regarded as being at the centre of advocacy of nursing care. Therefore, nurses are obligated to do their best to ensure excellent care of patients. In this way, nurses may be obliged to care for the patients in circumstances where the healthcare decisions conflict with the nursing beliefs of the nurses (Reising and Allen 2007). Based on the facts presented by the case study, Pamela failed to serve as a nursing advocate. This is because she willingly failed to deviate from the appropriate standard of care requiring a written statement despite the worsening condition of the patient. It can be argued that she declined to administer the anti-emetic without a written order because she was self-conscious that she has inadequate nursing skills. She was therefore unwilling to breach the standards of care that required that she should administer the anti-emetic with a written order. On the other hand, Jane failed to inform Pamela of her obligation as a nursing advocate. Indeed, the five elements for successful claim of negligence are apparent from their conducts. First, Pamela and Jane had failed to carefully monitor the patients changing conditions. She also failed to provide acceptable postoperative care (Ruthe and Ashley 2004a). Even though Pamela had reported the patient’s condition to the senior nurse, she had failed to document the patient’s condition. Pamela had also failed to question Jane’s order on the validity of administering Metoclopramide intravenously. This shows that even though she was aware of the codes of ethics, it was her responsibility to question Jane’s order. Nurses have a duty to question an order in the interest of patient. Therefore, both Pamela and Jane neglected their duty as a patient advocates although on different accounts. Indeed, if she had advocated for the patient, there could have been a better chance that the patient could not have suffered allergic reactions. Further, the patient could have received the appropriate nursing care. Second, Pamela breached her duty of care by failing to document. The main purpose of documentation is mainly to communicate the information about the patient to other health practitioners during the nursing process (Giordano 2003). The progress report, or any other documentation, should show evidence of the nursing assessment, patient diagnosis, and plan for intervention, assessment of the interventions implemented and the response of the patient. Within Pamela’s workload is a patient receiving intravenous infusion post-operatively. Despite the fact that the patient has vomited persistently, there is no report on the patient’s assessment, diagnosis, plan of intervention and response to intervention. It can be argued lack of the patient’s progress report is a direct cause of confusions regarding the appropriate intervention. Eventually, Jane administers the Metoclopramide intravenously on account of Pamela’s verbal report without the need to ask for a review of the patient’s progress report. The result is the patient experiences an allergic reaction that requires urgent medical attention. The failure to document the intravenous infusion post-operatively and the intermittent vomiting fell short of the standards of care. Standards of care demand that health care professionals should communicate effectively to avoid putting the patient’s health at risk (Ruthe and Ashley 2004c). Indeed, in nursing, standards of care refer to the practices that are expected of an average nurse. Documentation falls within the range of standards of care. Consequently, lack of critical information, unclear orders and lack of documentation of patient information resulted to communication errors (Eileen 2003). These led to wrong medication to the patient. Based on the facts of the case studies, several issues concerning the professional conduct and practice of nurses are observed. According to the ANMC’s (2006) codes of professional conduct, nurses are obligated to ensure that they operate in a safe and competent manner. It is the responsibility of the nurses to maintain the competences required for the specific circumstances underlying their practice. Generally, nurses’ professional conduct and practice refers to the ethical and legal responsibilities that require the nurses to demonstrate accountability of practice and satisfactory knowledge in compliance with the nursing and healthcare legislations. In the case study, several professional codes of conduct have been breached (Garner 2004). For instance, when nurses delegate an aspect of care, it is their responsibility to ensure that the delegation does not compromise the quality of safety of care patients. Pamela’s unwillingness to administer the anti-emetic without a written statement and putting the interest of the patient attests to breach of her duty to give precedence to the patient’s health safety. In any case, this could also be contradictory, as her unwillingness to administer the anti-emetic without a written statement indicates her awareness that undertaking certain activities that are not within her scope of lawful authority or competency may compromise the safety of the patient. Second, ANMC (2006) specifies that nurses should undertake their practice with the standards of profession and wider health system. Within this principle, nurses are required to practice in compliance with the wider standards of care that give precedence to the safety, quality and accountability for health system such as documentation. Further, nurses are required to participate in formal open disclosure procedures and event analysis. In the case study, Pamela and Jane are seen to have failed to undertake their practice with the standards of profession and the wider health system. For instance, there was failure to document the nursing assessment, patient diagnosis, and plan for intervention, assessment of the interventions implemented and the response of the patient to interventions. A case in point is Pamela’s failure to document patient interventions such as the administration of Morphine by intravenous infusion post-operatively and the client’s intermittent vomiting. Further, Jane failed to give Pamela a written order to administer anti-emetic. It can be argued that such failures compromised the patient’s treatment. This is because it contributed to ineffective communication on the progress of the patient and the due follow up. Third, nurses are obligated to practice nursing ethically and reflectively. Based on this code of conduct and practice, nurses are required to create and maintain suitable and effective nursing advice, support and care to the patients as well as to their colleagues. Further, nurses should asses their conducts and competency based on the standards of nursing practice. Nurses should also contribute to the professional growth of their colleagues (Queensland Health 2008). These professional practice and code of conduct provides that nurses conduct self-assessment, professional development as well as ensure research and evidence-based practice. In the case analysis, Jane and Pamela failed to practice nursing ethically and reflectively on different accounts. First, there was an apparent lack of research on the patient’s history or diagnosis. In any case, there was not documentation to show the patient’s diagnosis or report on progress. This attests to the fact that Jane and Pamela’s practice was not evidence-based. Further, since Pamela recently graduated as a registered nurse, ethically, it is expected that Jane, who is a senior nurse, should have sought to contribute to her professional development by issuing her a written statement to administer the anti-emetic. In addition, rather than independently administering the Metoclopramide intravenously, she could have guided Pamela through the process of administering the anti-emetic. As a senior nurse, Jane had the ethical responsibility of working interdependently and independently to ensure accountability and responsibility of the delegation of care to Pamela. Further, both Jane and Pamela failed to create and maintain suitable and quality nursing advice. For instance, since there was a lack of progress report on the patient’s condition, the two should have engaged in discussion to ensure effective analysis of the patient’s condition. This could have ensured that an appropriate intervention is recommended. Based on this, the patient could not have experience allergic reactions that required urgent medical attention. Two key relationships are featured in the case study, each characterized by different responsibilities. These include the nurse-nurse and the nurse-client relationship. Unlike the nurse-nurse relationship, the nurse-client relationship is both therapeutic and professional (CRNNS 2002). The responsibility of the nurse is to ensure that the needs of the patient are put first and foremost. In any case, the registered nurse has the responsibility to gain an understanding of the patient’s needs of care and to create an environment where care can be provided effectively, ethically and safely (CRNBC 2008; Eggert 2013). Basically, the nurse-client relationship is characterized by professional intimacy, empathy, respect, trust and power. In the case study, Jane and Pamela have failed on this responsibility. Indeed, it can be argued that the fact that the patient had vomited intermittently showed lack of professional intimacy often promoted by access to the patient’s personal information. For instance, failure to document the progress of the patient did indeed create an environment where care could not be provided ethically, safely and effectively. First, it was unethical. Second, lack of documentation on the patient’s history and responses to interventions made further interventions to be speculative rather than evidence-based (Dahnke 2009). The failures in nursing intervention may have been caused by the nurse-nurse imbalance of power, where the senior nurse possesses authority, while the supervised nurse follows instructions. The obligation to maintain standards of professional care lies with the nurses, despite the context of their relationship. An overriding principle is that nurses’ interpersonal relationship should not have a negative effect on the therapeutic needs of the patient. According to Fagin and Garelick (2004), this professional relationship is often affected by nurses’ code of conduct, decision-making and accountability. In the case study, the slow and ineffective decision-making is shown by the fact that Pamela relies on Jane’s authority and ethical responsibility to support her in containing the situation. However, she refuses to administer the anti-emetic to the patient without a written statement. Here, their relationship is complicated by the standards of care. In Fagin and Garelick’s (2004) view, a close relationship can produce some balance in power, although the final decision should rest on the doctors. In conclusion, a range of communication errors and interventions result due to the failure of Pamela and Jane to act as patient advocates. This is aggravated by negligence of care and lack of documentation. Based on these, AMNC professional conducts and code are breached such as conducting nursing practice ethically and reflectively. It is concluded that such scenarios could have been easily managed through a balance of power in the nurse-client relationship and the nurse-nurse relationship by ensuring professional intimacy. Reference ANMC 2006, National Competency Standards for The Registered Nurse, Australian Nursing and Midwifery Council Incorporated, viewed 25 Sept 2013, CRNBC 2008, Nurse-Client Relationships, College of Registered Nurses of British Columbia, Vancouver CRNNS 2002, Professional Boundaries and Expectations for Nurse-Client Relationships, College of Registered Nurses of Nova Scotia, Halifax Dahnke, MD 2009, The Role of the American Nurses Association Code in Ethical Decision Making, Lippincott's Nursing, viewed 25 Sept 2013, Eggert, M 2013, Impact of the Nursing Crisis on the Health Workforce: Submission to the Productivity Commission Health Workforce Enquiry, Australian National University, Medical School, Canberra Eileen, M 2003, "Nurses, Negligence, and Malpractice," American Journal of Nursing, Vol. 103 No. 9.pp54 Fagin, A & Garelick, A 2004, "The doctor–nurse relationship," Advances in Psychiatric Treatment, Vol. 10,pp. 277-286 Garner, G 2004, "Issues in Nurse Practitioner Developments in Australia," Cancer Forum, Vol 28 No.3, pp132-134. Giordano, K 2003, "Examining Nursing Malpractice: A Defense Attorney’s Perspective," Critical Care Nurse, Vol. 23 no. 2, pp104-107 Jackson, D, Peters, K, Andrew, S, Edenborough, M, Halcomn, E, Lucj, L, Salamonson, Y & WIlkes, L 2010, "Understanding whistleblowing: qualitative insights from nurse whistleblowers” Journal of Advanced Nursing, Vol 66 No. 10, pp2194–2201," Klainberg, M 2010, Today's Nursing Leader: Managing, Succeeding, Excelling, Jones & Bartlett Publishers, Sudbury, MA Queensland Health 2008, Modelling Contemporary Nursing and Midwifery a framework for shaping professional practice, viewed 25 Sept 2013, Reising, D and Allen, P 2007, "Protecting yourself from malpractice claims," American Nurse Today, Vol 2 No. 2 Ruthe C & Ashley, RN 2004a, "The Fourth Element of Negligence," Critical Care Nurse, Vol. 24 No. 4, pp78-79 Ruthe C & Ashley, RN 2004c, "The Third Element of Negligence," Critical Care Nurse, Vol. 24 No. 3, pp65-66 Ruthe C & Ashley, RN 2004b, "Understanding Negligence," Critical Care Nurse, Vol. 23 No. 5, pp72-73 Read More